Digestive and Liver Disease - Volume 48 - Supplement 2

Abstracts of the 22

National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231

e183

P.11.4

CLINICAL IMPACT OF ENDOSCOPIC ULTRASOUND–FINE NEEDLE

ASPIRATION (EUS-FNA) OF LEFT ADRENAL GLAND (LAG)

Assisi D.*, Forcella D., Lapenta R., Melis E., Filippetti M., Visca P.,

Facciolo F., Anti M.

Regina Elena National Cancer Institute, Roma, Italy

Background and aim:

A left adrenal gland (LAG) mass is found

at the initial diagnosis of non small cell lung cancer (NSCLC) in 5

to 16% of the patients and malignancy preclude surgery. Adrenal

gland is a metastatic site of other malignant neoplasms too.

Sensitivity and specificity of imaging techniques are currently

insufficient to differentiate benign from malignant lesions. Adrenal

massesaretraditionally sampled by percutaneous biopsy, but

endoscopicultrasound (EUS) through the esophagus is superior

to transabdominal ultrasound or CT scan for imaging the LAG. We

investigate the clinical impact of EUS-FNA of LAG in patients with an

established or suspected diagnosis of cancer.

Material and methods:

EUS with or without fine needle aspiration

(FNA) wasperformed in 10 patients with enlargedLAGor focal left

adrenal lesion (9 suspected adrenal metastasis from lung cancer and

1 suspected adrenal and pulmonary metastasis from renal cancer).

We performed EUS FNA both in lung mass and focal lesion of LAG

in onepatient withhistory of renal cancer and in four patients with

suspected lung cancer; in 3 patients withsuspected lung cancer we

performed EUS FNA both in station #7 enlarged lymph nodes and

focal lesion of LAG. In 2suspected lung cancer patients withstation

#7 enlarged lymph nodes and enlarged LAG with preserved shape

we performed EUS FNA only on MLN (mediastinal lymph node). We

used a 22 Gauge needle with a median of 3 passes of the needle.

Results:

The patient with a history of renal cancer had negative LAG

butpulmonary metastasis from renal cancer (sent to pulmonary

metastasectomy); one case with diagnosis of adenocarcinoma

both in lung mass and in LAG was sent to chemotherapy; in other

2 cases LAG was negative and MLN biopsies were diagnostic for

adenocarcinoma (sent to neoadjuvant chemotherapy); in 1 case both

LAG and MLN were diagnostic for neoplasia (sent to chemotherapy);

in 3 cases lung mass biopsies were diagnostic for cancer and LAG

negative (sentto surgery).

Conclusions:

Theseresults suggest that EUS FNA of left adrenal gland

is a safe procedure with a high diagnostic yield in the diagnosis of

left adrenal gland. FNA of LAG and enlarged MLN have a real clinical

impact on management of disease and avoiding futile surgery.

P.11.5

THE USE OF A POCKET MOBILE ULTRASOUND DEVICE IN THE

EVALUATION OF PATIENTS WITH SUSPECTED BILIARY DISEASE

Montanari M.*, Peder J., Zilli A., Orlando S., Bisso G., Segato S.

UO di Gastroenterologia ed Endoscopia Digestiva. Azienda

Ospedaliero-Universitaria Macchi., Varese, Italy

Background and aim:

The accuracy of a physical examination for

patients with a suspected biliary disease is often poor and it requires

further tests to assess the diagnostic hypotheses. Adding the use of

pocket mobile ultrasound devices (PUDs) to physical examinations

could lead to an incremental benefit in the evaluation of patients

with biliary disease. We assessed whether the use of PUD should

be recommended, in the evaluation of a patient presenting suspect

of biliary disease, to improve the diagnostic accuracy of a physical

examination and to assess the appropriateness of further testing.

Material and methods:

We conducted a prospective study for eight

months from February to September 2015 involving 31 patients,

which were evaluated in the emergency room for suspected biliary

disease. All the patients were submitted to evaluation with PUD

(V-Scan GE) looking for dilation of the biliary tract or biliary stones.

The images were collected by a physician, who is an expert in

abdominal ultrasound.

We then monitored the following diagnostic of these patients

without affecting it, and evaluated the correlation between the test

and results of gold standard methods (Eco /RMN/TC).

Results:

Of the 31 patients, in 77% of the cases the PUD’s examination

confirmed the suspected diagnosis. The correlation with the

standard ultrasound was equal to 87%, 91% with TC and 90,5% with

MRI. It was also possible to assess the sensitivity and specificity,

respectively equal to 88,2% and 100%.

Conclusions:

PUD can be used in combination with physical

examination in the first assessment of a patients presenting

suspected biliary disease. In fact, this tool presents good sensitivity

and specificity in identifying the presence of stones and / or

dilatation of the bile ducts. Its use could then optimize the demands

of subsequent investigations, by reducing waiting times and costs.

P.11.6

ECHOENDOSCOPIC ETHANOL ABLATION OF TUMOR COMBINED

TO CELIAC PLEXUS NEUROLYSIS IN PATIENTS WITH PANCREATIC

ADENOCARCINOMA

Facciorusso A.

, Di Maso M.*

, Barone M.

, Larghi A.

Costamagna G.

, Muscatiello N.

University of Foggia, Foggia, Italy,

University of Bari, Bari, Italy,

Catholic University, Rome, Italy

Background and aim:

Endoscopic ultrasonography (EUS) guided-

celiac plexus neurolysis (EUS-CPN) is effective in relieving pain

in pancreatic cancer (PC) patients, but with often suboptimal and

transient results. This study is aimed at comparing the efficacy and

safety of EUS-guided tumor ethanol ablation combined to CPN with

respect to EUS-CPN alone for pain management in PC patients.

Material and methods:

Among 123 unresectable PC patients

referred to our Institution between 2006 and 2014, 58 treated with

EUS-CPN (group 1) and 65 with the combined approach (group 2)

were compared. Logistic regression models were applied to identify

predictors of pain relief, while time-to-event data were compared

by means of log-rank test.

Results:

The two groups presented similar baseline clinical and

tumoral parameters. Pre-procedural visual analogue scale (VAS)

score was 7 in both groups (p=0.8) and tumor max diameter was

38 mm (range 25-59) in group 1 and 43 mm (22-59) in group 2

(p=0.4). The combined treatment increased the pain relief and the

complete pain response rate (p=0.005 and 0.003, respectively).

Median duration of pain relief was 10 (7-14) and 18 (13-20) weeks in

the two groups, respectively (p=0.004). At multivariate regression,

initial VAS score and EUS technique adopted resulted significantly

associated to pain relief. No severe treatment-related adverse events

were reported. Median overall survival was 6.5 months (5.1-8.6) in

group 1 and 8.3 (6-11.4) in group 2 (p=0.05).

Conclusions:

EUS-guided tumor ablation combined to CPN appears

to be superior to standard EUS-CPN in terms of pain control and

overall survival.

P.11.7

PANCREATIC FNA: CAN WE GET RID OF THE MICROSCOPE?

Togliani T.*, Mantovani N., Vitetta E., Savioli A., Troiano L., Pilati S.

S.S.D. di Endoscopia Digestiva, Azienda Ospedaliera Carlo Poma,

Mantova, Italy

Background and aim:

EUS-FNA is an essential procedure for

obtaining a tissue confirmation of solid pancreatic malignancy but

at least 5 to 7 needle passes are generally needed to have a good

accuracy. In this study we checked if the real-time macroscopic